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Integrating medical abortion into safe abortion services: experience from three pilot sites in South Africa
  1. Mary Kawonga, MBChB, FCPHM (SA), Senior Specialist1,
  2. Kelly Blanchard, SM, Senior Researcher2,
  3. Diane Cooper, PhD, Director3,
  4. Lee Cullingworth, MBChB, DFSRH, Senior Researcher3,
  5. Teresa Harrison, SM, Program Advisor4,
  6. Kim Dickson, MBChB, MSc, Clinical Director5,
  7. Claire von Mollendorf, MBBCh, BScMedSc, Deputy Director5 and
  8. Beverly Winikoff, MD, MPH, Director6
  1. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  2. Ibis Reproductive Health, Cambridge, MA, USA
  3. Women's Health Research Unit, University of Cape Town, Cape Town, South Africa
  4. Constella Group, Durham, NC, USA
  5. Reproductive Health and HIV Research Unit, Johannesburg, South Africa
  6. Gynuity Health Projects, New York, NY, USA
  1. Correspondence to Dr Mary Kawonga, School of Public Health, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, Gauteng 2193, South Africa. E-mail: mary.kawonga{at}


Background and methodology South Africa's Choice on Termination of Pregnancy Act of 1996 provides for safe termination of pregnancy (TOP) in designated facilities in the public and private health sectors. In 2001, mifepristone-misoprostol medical abortion was approved for TOP up to 56 days, but this method is not yet available in the public sector. Information on the operational requirements for integrating mifepristone-misoprostol medical abortion into South Africa's public sector safe abortion services is required to guide policy decisions. This study trained health workers to provide medical abortion to 290 women attending three TOP sites. Prospective data were collected to ascertain women's experience of the method, pregnancy outcome, women's and provider's acceptability of the method, and the operational requirements for providing medical abortion.

Results Twenty-nine (10%) women were lost to follow-up; 261 (90%) women had a confirmed abortion outcome, of whom 93% had a complete abortion. Given the option, the vast majority of women opted to use misoprostol at home. No serious side effects were reported; pain (66%), and heavy bleeding (67%) were the most common side effects. Most (96%) women were very satisfied with the experience. Health providers were satisfied with providing medical abortion and recommended its introduction to complement existing surgical TOP services.

Discussion and conclusion This study demonstrates that integration of medical abortion into public sector services is feasible. The results of this study will guide policy decisions about integrating medical abortion into South Africa's public sector safe abortion services, within the context of the existing enabling legislative framework.

  • medical abortion
  • mifepristone
  • misoprostol
  • public sector safe abortion services
  • south africa

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